Category Archives: Happiness

Wrestling with OCD

If you have suffered with Obsessive Compulsive Disorder (OCD), or know someone who has, you are probably familiar with those distressing, intrusive thoughts that create so much anxiety. Traditional psychoanalysis used to focus on the content of those thoughts and seek to uncover the deep, buried wounds and wishes that led to these strange, seemingly alien notions. Thus the woman who was obsessed with the fear that her child would get hurt walking to school might be analyzed and advised that she seems to have a deep resentment against the child and all the responsibilities of motherhood and the worry is really an expression of an unconscious wish to be rid of the child. Talk about a guilt trip…!

Modern research and practice in treating OCD tends more towards the notion that everyone’s brain generates random and sometimes pretty crazy-sounding thoughts. Thus, the treatment is much less about wrestling with the particular content of the OCD thoughts and more about learning to compassionately notice that thought happening among all the other thoughts firing off like popcorn in the typical brain, use strategies to calm down the anxious physical reaction to the thought and refocus, gently and purposefully, on what one would rather think about at that moment in time. It stops becoming “Don’t think about X,” (try that: right now, I forbid you to think about pizza. Ha – how long did it take to imagine a pizza?). Instead, it becomes, “Yup, there’s that thought about X…and now I will take a deep breath and refocus on what I was doing/what’s going on right here and now.”

This is what mindfulness, stress management and cognitive-behavioral therapy can do, together, to help with OCD. The brain changes in response to choosing these behaviors, and the degree of physical distress decreases throughout the whole body.

If you are suffering with OCD, this kind of very well-researched approach may be what you need. Please contact a professional in your area if you think this might be helpful for you.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Cut Them Some Slack

Doing unto others as we would have done for ourselves…well, there is one thing that most people tend to do for themselves that they are often slow, reluctant and resistant to do for others: cut them some slack. Consider the historical narrative on this:

Jesus of Nazareth: “Why do you notice the splinter in your brother’s eye but not perceive the wooden beam in your own?” (Luke, 6:41, NAB)

Soren Kierkegaard: “Most people are subjective towards themselves and objective towards others, frightfully objective sometimes – but the task is precisely to be objective towards oneself and subjective towards all others.” (Works of Love)

CS Lewis: “…It is no good passing this over with some vague, general admission such as, ‘of course, I know I have my faults.’ It is important to realize that there is some really fatal flaw in you: something which gives the others just that same feeling of despair which their flaws give you. And it is almost certainly something you don’t know about…” (Essay: The Trouble with “X”, from God in the Dock)

Psychologically, of course, it makes sense: we, after all, know what we intend to do/say; we have deep awareness of all the people and events that obstruct our good intentions. Meanwhile, we have no clue – or concertedly avoid taking notice of clues we trip over – about whatever obstacles and heartaches might underlie others’ disappointing and often frustrating behaviors. We cannot know what it is like to have the particular limitations that someone else has –anymore than they can understand the particular limitations we tote around with us.

Sometimes someone will say to me in the context of therapy how badly they feel that they are struggling with some particular issue – anxiety, or depression, for example – when (from their perspective) other people all seem to be going around, carefree and without this sort of anguish. In a country in which 20% of women and 10% of men are prescribed antidepressant medications each year, and who knows how many various prescriptions for anxiety, it hardly seems fair, to oneself or others, to assume that everyone is skipping along as carefree as they often very deliberately attempt to appear. Then there are physical pains and illnesses; the sufferings of loved ones; the anxiety for a loved one in a danger zone; grief; loneliness. These are so often invisible except for the side effects of passing crankiness or thoughtlessness or scatterbrained-ness that annoy other people who are, to quote Kierkegaard, being “objective” about others.

For the person who is suffering and, unable to see evidence of suffering in others, believes s/he is alone, it is disheartening. To be so alone in suffering…! But no one is alone in their suffering.

Not all the objective/subjective dichotomy concerns suffering. Sometimes it is about unseen limitations or differences. No doubt you have something you are not naturally good at doing. Perhaps it’s spelling, or “being handy,” or math. If you are a grownup who is doing well in life, you may have turned this into a kind of joke, or perhaps you use this as exhibit A, the evidence that you know you’re not perfect: “Oh, I know I’m far from perfect…you should see the disaster my checkbook is,” but in fact you have a certain secret pride that you do not have to bother with this, or that your flaw is so small and even borders on not being a real defect at all…and, after all, at least you are not “stupid/lazy/arrogant/whatever you perceive in someone else.” Yet unless you are in that experience, you cannot understand the frustration of someone with a brain injury who on the one hand knows that a certain skill set used to come naturally but is now a fuzzy memory and source of perpetual struggle. You cannot know what it is really like for someone with an IQ thirty points below yours to struggle through a complex and fast-paced world, when their processing speeds are so much slower, and you likewise cannot know what it might be like for someone with an IQ thirty points higher than yours to bear patiently with you.

Part of good psychotherapy, like good spiritual growth, is becoming aware of one’s flaws – not for the purpose of self-recrimination and useless shame, but as opportunities for growth of oneself as well as a growth in compassion for other people. The process, once begun, is the work of a lifetime.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

If you won the lottery…!

We all know the stats: that six months after a major windfall, such as the lottery jackpot, people are no happier than they were before they won. Most of us assure ourselves, WE would do better. WE would know how to manage that blessing in such a way as to increase the happiness of many people – including ourselves – on an ongoing basis. WE would be happier, not succumb to dopey decisions and would never blow up our lives with self-destructive, self-indulgent bad behavior.
Here’s a question: what would you do if you won the lottery, and why aren’t you doing some version of that already?
If you imagine you’d travel, see new places and try new cuisines, are you saving money for a trip and seeking free/cheap adventures in your own area, experimenting in the kitchen and otherwise exploring here at home?
If your job is a poor fit, are you meeting your intellectual and creative needs via outside pursuits, or investigating how to transition to something that’s a better fit, or are you just feeling “stuck”?
Most changes people imagine making after winning a lottery are really superficial and thus, much to their surprise, they show up in that new, changed life with the same “them,” with all their flaws, quirks, and preferences. That means that we all would tend to level out at whatever our prior level of contentment was, pre-jackpot. If you’re a happy person, you’ll keep on being happy…and if you’re cranky, well, you’ll just be a rich, miserable person to be around instead of a not-rich miserable person. Worried people will keep on worrying until they decide to learn how to change that – which doesn’t require a lottery jackpot.
You can be happier today. You can find a new adventure in your town this weekend. You can learn something exciting and be on the way to mastering a new skill this week. Alternately, you could sit around and wait to win the lottery. You get to pick.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC
© 2016
Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Too busy!

People brag about the strangest things.

Not getting enough sleep is one; are Americans in some sort of dysfunctional competition to see who can get by on the least possible sleep – regardless of the effect on their mental and physical health?

Another is being busy – so very, very busy – that one could not possibly do anything healthy, or creative, or refreshing in any way.

Is it real busy-ness? It’s hard to say, but I have my suspicions that it often comprises some combination of underestimating how much time is frittered away on time-wasters, taking on a lot of extra and unnecessary tasks, and, sometimes, more than a hint of pride. You know, the people who find out you actually read books in the evening or squeeze in a date night with your spouse and give that little smile and a hint of a sniff when they say, “Well, it must be nice…” Well, yes, actually, it is. Very nice.

Pride, or arrogance, aren’t necessarily obvious. Healthy humans have a normal, natural need to feel needed and wanted. This is a good, but the fear that somehow your absence will cause all of creation – or at least your workplace or the kitchen at home – to immediately crumble into dust is not good. Even Jesus and Moses sometimes sneaked off for some very necessary R&R, either to be alone with God or also with some of their most loved, trusted friends.

Some people are going through a stage of life that is very busy. People with school-aged kids who each  participate in one extra activity will indeed be temporarily overly busy, driving to practice or lessons. They check homework, look under the sofa for shin guards, and use their vacation time for pediatric appointments for yet another ear infection. This stage is transient. Even too-busy parents, though, often hide time-wasters into their day.

When someone asserts always being “too busy” to do things they claim they really want to do, then I suspect that perhaps they don’t actually want to do those things. It would be better to say, “Oh, no – last thing I want to do is be stuck in a gym five mornings a week,” then to dodge exercise by pretending they are just too, too busy. Once they are honest about the issue (apparently they would rather do something else than spend hours on the human version of a hamster wheel) they are free to figure out how to meet the essential need (enough exercise to stay healthy) and stop dodging reality with brag-worthy busy-ness.

It’s hard to give up the busy excuse to oneself. It might be a polite dodge to other people (but remember that “let your yes mean yes and your no mean no” admonition?) but it’s just pointless to lie to oneself.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

A little out of sync…

Intellectually gifted children are a challenge for grownups.

Their ability to learn and apply information may be far ahead of their peers but their emotional and motor skills may be completely normal (read: average and right on schedule). So your highly gifted six-year-old, who can visualize Johnny Depp’s pirate ship but whose little fingers can only manage 5-year-old’s motor skills, will be angry and frustrated to the point of tears over a boat that looks perfectly fine to you. Your gifted twelve year old will, with the emotional fragility of a middle-school-aged heart, grapple with the existential questions peers more often face in college.

This kind of asynchronous development is hard for the child, too…and will continue to be so, until adulthood. It’s easier for adults to find a few intellectual peers with whom to deeply connect. The more gifted the child, the harder this will be, simply because of the mathematical odds. Intellectual giftedness comprises only 2% of the population. Highly gifted persons are less than 1/1000 of the population; for them, the odds of finding someone on par, or, an even happier event, encountering someone sharper in intellectual terms, is slim. It’s important for grownups to be aware of the interior struggles gifted children face and provide opportunities for support, encouragement and sometimes some careful education on why they feel so different from other kids.

Add to this gifted kids’ tendency to need a little less sleep, be a little more bouncy, be in a hurry to learn and do, ask a lot of questions…or, conversely, be very quiet, observant and introverted, and the challenge for parents and teachers becomes clear.

Interested in learning more? There are a lot of resources out there: American Mensa and SENG are two excellent sources of information and support for the gifted child (or grownup) in your life.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

What can it be, besides ADHD?

Your child is bouncy. He doesn’t seem to pay attention; she forgets to follow through on tasks. The book bag is a disaster area; necessary books never seem to make it home; and you regularly have to turn around and go home to pick up shin guards or ballet shoes.

Well, what can it be, besides ADHD – the psychiatric diagnosis of Attention Deficit/Hyperactivity Disorder, diagnosed off a checklist and sometimes suspected of being over-diagnosed?

The symptoms associated with ADHD can be due to a wide variety of issues; here are a few:

  1. Stress at home or in the environment. If you are having marital or other family difficulties, your child is stressed – whether you know it or not. Research indicates that a, adults are pretty lousy of telling when children are anxious or worried and b, the children of adults with marital problems, when tested in research studies, have high levels of stress chemistry metabolites in their urine.
  2. Maybe it’s not at home; maybe it’s the environment. Live in a noisy and/or high crime neighborhood? Is your child bullied or afraid of being bullied at school? Sources of ongoing stress will interfere with the parts of the brain that are important to focus, attention and memory.
  3. Insufficient sleep. Is your school-age child getting 9 or 10 hours of quality rest per night? Falling sleep by television, computer, or with a cell phone close at hand? These will all interfere with quality and quantity of sleep.
  4. What are overtired kids like? You know what you do when you’re driving late at night and you are too tired to be driving – so you bounce in the seat, sing too loudly and pretend having the windows open will magically keep you alert? Yeah, well…meet the 3rd grade kid who is up too late because of football or soccer practice a few times a week and fidgets around looking dazed in class.
  5. Insufficient exercise. The recommendation for children is two hours of physical activity a day – real activity, not standing-around-hoping-coach-lets-me-play-this time activity.
  6. Boredom. Brains + boredom = either shutting down and not trying at all OR driving grownups and other kids bonkers. Look out for the introverted or shy child who may shut down and go into dreamland; a lot of gifted children are very introverted and self-contained, and unlikely to be overtly disruptive. They simply tune out.
  7. Frustration. A child who is having difficulty – perhaps an undiagnosed or insufficiently supported learning disability – will often give up and stop trying. Remember that children personalize things; if they are struggling and the grownups act like they “should” be able to “get it,” the child assumes the adults know best and that the child must be flawed/”stupid” etc.
  8. Your (or some other involved grownup’s) inconsistency. If you flipflop on rules, fail to follow through, and run an unpredictable life for yourself and your child, it’s not fair to look at the child who seems scattered or (more likely) is gambling on this being one of those times when you are too stressed or preoccupied and let things slide, and blame the child.

You’ll notice that none of these issues can be blamed on the child. These are all grownups-need-to-pay-attention flags, not “naughty kid” flags. So, before you assume your child has a brain disorder, rule out the many factors that we grownups often unwittingly inflict on children and see if, with a few months of more consistent attention to these risk factors, your child’s behavior and morale improve.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

 

Why are personality disorders so difficult to treat?

Why are personality disorders so difficult to treat?

Well, there’s a complicated question! This post attempts to present an overview response.

A personality disorder, like just about all mental disorder diagnoses, is made based on a checklist of complaints, symptoms, and observations. However, personality disorders are very different from what we normally think of as emotional problems.

Consider, for example, depression. “Depression” is diagnosed when 2 weeks have passed and certain criteria have been met (and there’s no “pass” given for grief or other traumatic events in the new diagnostic manual, although we’re supposed to note it in the records). Most people know when they’re sad, irritable, unhappy, and hopeless. It feels awful and they want to get that bad feeling off of them. Some people might not think of it as “depression.” They might identify it as a “low time,” or it might be grief, or a normal adjustment to a new phase of life such as marriage, an empty nest, or graduating from college. It might be a normal but very painful response to some new curveball life has thrown at them: an illness, a layoff, retirement, etc.

A personality disorder is different because it is pervasive; like the personality of any person, it is part of everything. Your personality impacts how you interpret everything that happens, the way you react to people and events, the emotions you experience. This goes for healthy people as well as those whose patterns are far enough from the big, wide range of normal to merit a “disorder” status. So, when someone seems to have a personality disorder (say, narcissism), they are not experiencing their diagnosis as a messy, icky experience to be stopped. They are rolling along (over other people) and having their life. Everything comes through a lens that assures them that they are special, entitled to preferential treatment and to have their way, and, well, let’s face it, just better than us. Problems are experienced as due to the outside world and their own role in those problems is not apparent.

From a therapist’s perspective, when someone comes in with depression, even if that’s not what they, or we, might call it, they know they are unhappy and they want very much to feel like themselves again. They are hopeful that a counselor can help them push through this difficult time.

When someone who meets criteria for a personality disorder comes to treatment, it’s usually because of some other issue, such as work or relationship problems. Remember that each of us is walking around, seeing the world through our own eyes and interpreting everything we experience, including our own thoughts and feelings, through our unique mental structure. You build that mental structure from the earliest moments of life. Is the world safe? Are my needs met? Are the grownups who tend to me patient, gentle and kind? Babies are already sorting out information and creating a set of basic assumptions about the world that will become essential aspects of their personality. It’s so deep, it’s hard to not take for granted that our way of making sense of things isn’t necessarily the only, or best, way. So when patterns of problems arise with colleagues, bosses or family, it’s hard to believe that the problem is fundamental to our mental structure; it defies logic and could be very insulting. The person may be suffering terribly, every day. This is definitely the case with some of the personality disorders, such as Borderline Personality Disorder, Avoidant Personality Disorder and Dependent Personality Disorder. Whether these or any of the personality disorder diagnoses, the person did not choose this burden and it isn’t their fault. However, presenting it as an internal problem – to them – can feel like blaming and attacking – which is definitely not the therapist’s intention.

Imagine if something terrible happened to you: a tsunami. Your workplace is destroyed. You lose your house. You lose your stuff. You catch a mosquito-borne illness and suffer long-term ramifications. It’s a series of terrible events and you find yourself traumatized and perpetually anxious. Is that anxiety your fault? Certainly not. Just so, the early life experiences that set people up for the challenges we call personality disorders are not their fault. However, it’s a problem that they can learn to heal, but that can sound like blaming the victim. Thus, if someone meets criteria for a personality disorder, trying to sell them on dealing with the personality disorder is pretty much like saying, “Look, an awful lot about the way you think and respond to things is kind of messed up. But, never fear! Together we can bulldoze your personality and how you think, feel and behave, pour a new slab, and then we’ll rebuilding you from the ground up. You’ll learn new ways of thinking, feeling and behaving.”

Even when it’s dressed up in tactful, compassionate psychological language, that, my friend, is a very hard sell indeed.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Oh, the drama!

It’s about 2/3 of the way through the spring term, so it’s time again for my intro psychology students to learn about the various personality disorders, as defined by the American Psychiatric Association. One interesting one – and not necessarily in a good way – is Histrionic Personality Disorder (HPD).

Traditionally, HPD was estimated to occur in perhaps 2-3% of the population. You know these folks; you’ve known them all your life. They’re exciting, intense, and fun; the life of the party, the center of attention…and they can’t turn it “off” when appropriate. It’s the “friend” who wears a very well-fitted white dress to your wedding; the family member who always has to make it “about them,” when it’s very, very much about someone else; the middle-aged parent who is trying to compete with a teenaged child to the point of embarrassment (for the child, that is). They lack empathy for anyone but themselves, but can emote with the best of them. Recent studies indicate that incidence of HPD is exploding – with some estimates as high as 27% of the young adult (under 35) population now meeting criteria for the psychiatric diagnosis. It’s thought that the two-generation long emphasis on having high self-esteem absent any achievement of good character or performance might be involved, as well as the current culture that elevates attention (any attention) as better than just chugging along, living your life happily with the people you love.

Which of our grandparents would ever, in million years, have imagined everyday people talking about how many “followers” they have, as if they were Jesus?

Like almost all psychiatric diagnoses, HPD is defined by a checklist; meet enough criteria according to the clinician holding the checklist, and you’ve earned the label. Of course, someone with HPD isn’t coming for therapy for help with HPD. Others may come for help with them, or it may become apparent within the context of counseling for some other issue: relationships, work conflicts, etc.   It’s sad, really, that it can be so difficult to realize one needs help, because at the root of this is a small child, still jumping up and down crying out, “Mommy! Watch this! Mommy – look at me!” and that small child in the unconscious just doesn’t realize that all the jumping up and down cannot make them feel “seen,” and they need to find other ways – more adult, meaningful ways – to feel connected and recognized. After all, everyone wants to be seen by eyes that love them; didn’t the film Avatar touch on that well, where the most intimate thing people could say to another living being was, “I see you”?

Like some of the other personality disorders, particularly Antisocial Personality Disorder, Borderline Personality Disorder, and Narcissistic Personality Disorder, the person with Histrionic Personality Disorder will seem fine…in fact, better than fine. All four can be very charming, interesting, and fun. They can seem special and their attention can make the next victim caught in their vortex feel special until all heck breaks loose.

Be compassionate but beware. No matter how wonderful, loving and patient you are, healing the wounded heart under HPD is not a one-man or one-woman task.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

What are you waiting for?

The American Association for Marriage and Family Therapy asserts that the typical couple coming in for counseling has had difficulties for over five years…which makes me wonder, what are they waiting for?

There are a lot of seemingly perfectly sensible reasons to postpone counseling when things start to go awry:

“It’s expensive.” This is true; counseling does cost money and relationship counseling is an out-of-pocket expense. Still, most therapists are cheaper than two retainers, two divorce attorneys, a mediator, a parent coordinator, etc…

“I don’t want to be told what to do.” Well, a good therapist isn’t just going to tell you what to do. A therapist is going to be asking a lot of questions, having you fill out a lot of questionnaires, and trying to develop a very clear picture of your relationship’s specific strengths and the particular types of problems each of you identify. That way, research-recommended approaches can be matched to the problem(s) of the particular couple.

Fear. Don’t a lot of people fear that it’s going to be like that old Simpsons episode, where, after Marge vents for hours, the therapist turns to Homer and says something to the effect of, “I’ve never said this before, but it really is all your fault.” That’s not what happens in real life.

Shame. So many people suffer with shame over the difficulties they are having. Marital difficulties feel like a failure. Yet, if marital problems were some rare, shameful thing, why are there so many marital therapists? We have our own doctoral programs, professional licensure, and organizations. Beyond that, other non-specialists in the mental health professions also offer couples counseling.   Shame can be overcome by getting help and feeling less alone in the suffering.

The Ostrich. Just try to ignore it and hope it goes away: the addiction, the affair, the endless disputes about parenting or money or values and ethics. Some things, ignored, will go away: a minor cold, a pimple, a minor aggravation of the day. Other things, though, just fester and turn into a nasty emotional infection: resentment, trauma, guilt, hurt.

If your relationship is suffering from feelings of distance and disconnect, or seems to be a vortex of repetitive arguments, counseling could be very effective. Often, five or six appointments, spread out over four to six months, can make a world of difference when both parties are willing to work at changing patterns of behavior and experimenting with new ways of interacting.

It’s important to find a counselor who is a good fit. Call a few of us; talk for a few minutes; get a sense of style and see who seems like a good fit for the two of you.

Be bold. Push past shame and fear; challenge your inner ostrich. Then start to feel happy again.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Toxic Myths, revisited

A lot of people ask about toxic myths: what does that mean? Why “myths?” (I’d like to say, well, buy the book, and sometimes do).

The toxic myths are examples of lies dressed up as truths. Our culture is seething with them, but in Toxic Mythology, I only addressed a few.

For example, consider the myth that people can compartmentalize their lives. Someone can, within this myth, be an absolute scoundrel in their personal life but supposedly be capable of being completely trustworthy and honorable in their public/vocational role.   Conversely, they can (per the myth, at least) be a sociopath in their professional life but be kind, tender and good in private.

So…if you buy this myth, you have to be willing to:

Vote for someone who swears to uphold a particular principle while having a personal and/or professional life littered with betrayals and a habit of acting on expediency, not principle;

Believe your child who promises she didn’t really cheat on that exam or plagiarize on the paper (despite the software evidence) after same child was grounded for “borrowing” money out of your wallet without permission.

Keep on an employee whom you overhear lie to customers because you haven’t caught that employee lying to you.

Convince yourself that your gossipy acquaintance never, ever would talk about YOU behind your back.

Does any of that sound reasonable? Of course not; these are, however, the toxic myth in action. Our culture tells us that it’s perfectly reasonable to believe that compartmentalization of character is possible and (further) that we should be “judgmental.” That’s another myth for another day.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.